Case 128 – Update 4!

Thank you for everyone’s ongoing contributions!

The patient underwent further intra-abdominal surgery without significant bleeding complications following the management below:

  1. Vitamin K 10mg IV
  2. Co-trimoxazole stopped
  3. IVIg 2g/kg over 2 days
  4. Platelet transfusion (random ABO and D compatible with good 15 minute increment – plt count went from 25 to 51)
  5. 2 units packed red cells

Unfortunately 3 days later our 65 year old patient has deteriorated and is now on critical care having been intubated and ventilated. A CTPA and CT abdo-pelvis was performed and this has shown:

  • Bilateral segmental PEs
  • Fully occluded portal vein thrombosis
  • Mild improvement regarding appearance of pancreatitis

Repeat bloods are as follows:

  • Hb 78 Plts 39 WCC 5
  • PT 18 APTT 39 Clauss fib 3
  • eGFR 31 Bili 125 ALT 320 Alk phos 110 CRP 265

Questions:

  1. How would you manage our patient now (from haem perspective)?

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